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Non-Communicable Diseases WatchJune 2014
Keeping Children Safe from Unintentional Poisoning in the Home
Key Facts In Hong Kong, unintentional childhood poisoning is not uncommon. Between 2011 and 2013, data from
16 Accident and Emergency Departments under the Hospital Authority showed that there were
793 unintentional poisoning cases among children aged 14 and below, in which 559 (70.5%) cases
happened in the home.
Among the unintentional childhood poisoning incidents in the home, more cases happened in boys
(54.2%) and the majority involved children aged 4 or below (88.0%). The most common poisoning
agents involved were medications (63.5%), household products (15.4%) and pesticides (6.2%).
Tips for Preventing Unintentional Childhood Poisoning in the Home
While parents and carers should take time to teach children about poisoning and tell them not to put
things into their mouth casually, the best way to keep children safe from poisoning is to ensure that they
cannot get to them.
Check every corner in the home for poisoning agents (such as medications, cleansing products
and chemicals, cosmetics and personal care products, poisonous plants, cockroach baits and rat
baits). Put all poisoning agents out of reach of children.
Keep poisoning agents in their original child-proof and clearly labelled bottles or containers.
Use child-resistant locks on cupboards containing cleansing fluids and other household chemicals.
Dispose out-of-date or unwanted medications, chemicals and batteries properly.
Keep children away from treated areas where pesticides are applied. Keep a close eye on
young children in and around the home.
Read the labels carefully and follow the instructions strictly when giving medications to children.
Do not stock medications that are not needed.
Recognise the signs and symptoms of poisoning, such as hacking cough or trouble breathing;
nausea and/or vomiting; abdominal pain; swollen or red eyes; rash, red or burned lips, mouth or skin;
seizures; drowsiness or unconsciousness (in extreme cases).
Act fast in case of suspected poisoning: keep calm; seek medical attention promptly;
call 999 emergency hotline immediately if the condition is serious.
This publication is produced by the Surveillance and Epidemiology Branch, Centre for Health Protection of the Department of Health
18/F Wu Chung House, 213 Queen’s Road East, Wan Chai, Hong Kong http://www.chp.gov.hk All rights reserved
Non-Communicable Diseases Watch June 2014
Page 2
Keeping Children Safe from Unintentional Poisoning
in the Home
Many people think that the home is a place where
children will be safe from all harms. However, the
home and its surroundings can sometimes be
dangerous for children. Studies have shown that
most childhood injuries occur in the home itself,
including unintentional poisoning.
By definition, ‘poisoning’ refers to an injury that
results from being exposed to an exogenous
substance that causes injury or death.1 In fact,
poisons can be found in everyday items that are
located in the home – kitchen, bathroom, laundry
room, living room, bedroom, garage, closets and
storage area. They can be ingested, inhaled or
absorbed when in contact with skin or mucous
membranes. Common poisoning agents found in the
home include medications (such as over-the-counter
or prescription medications and herbal products),
alcohol, household cleansing products (such as
bleaches, disinfectants and detergents), cosmetics
and personal care products (such as perfumes,
mouth washes and hair dyes), organic fuels and
solvents (such as hydrocarbon fuels, paint remover
and glue), pesticides (including insecticides and
rodenticides), poisonous houseplants (such as peace
lily and oleander), and insect bites or stings (such as
red fire ants, spiders, bees or wasps).1 While most
unintentional childhood poisoning incidents in the
home happen suddenly, some develop progressively
over time due to repeated or chronic exposure to
small amount of the toxic substances (such as lead
whic h is a heavy metal and they can be present in
contaminated dusts, lead-based paint and toys).
Global Epidemiology of Unintentional
Poisoning in Children
Mortality and Morbidity
Although significant progress in public health
policy has been made towards the protection of
young children from the harms presented by
exploratory ingestion of medications in the past
decades (such as the advent and requirement of
child-resistant packaging on most medications and
poisonous substances), poisoning remains as an
important cause of mortality and morbidity among
children globally.2,3 As the Global Burden of
Diseases, Injuries, and Risk Factors Study 2010
(GBD 2010) reported, the global burden of disease
attributed to poisoning in children aged 1-14 had
reduced substantially between 1990 and 2010.
Nevertheless, poisoning still accounted for over
17 000 deaths and around 1.5 million of disability-
adjusted life year (DALY) lost (i.e., the number of
years lost due to ill-health, disability and early
death) among children aged 1-14 worldwide in 2010
(Table 1).4
Table 1: Estimated number of deaths and disability-adjusted life year (DALY) lost due to poisoning
worldwide among children aged 1-4, 5-9 and 10-14, 1990 and 2010
Age (year)
Estimated number of deaths Estimated number of DALYs
Year
1990
Year
2010
%
change
Year
1990
Year
2010
%
change
Age 1-4 26 228.8 11 541.1 ↓ 54% 2 203 539.8 969 042.5 ↓ 54%
Age 5-9 6 364.7 3 095.4 ↓ 50% 508 425.4 248 799.6 ↓ 50%
Age 10-14 5 368.9 3 254.7 ↓ 38% 401 713.1 245 063.6 ↓ 37%
Source: Institute for Health Metrics and Evaluation, University of Washington.
Page 3
Risk Factors
Childhood poisoning does not ‘just happen’,
but very often involves a complex interplay of
factors related to the child, poisonous substance,
environment and family behaviour.
Age has a strong association with childhood
poisoning as it determines the behaviour, size and
physiology of the child, thus influencing types of
exposure and outcome. As most substances increase
in toxicity as the dose increases relative to body
mass, children under the age of 1 year have the
highest rate of fatal poisoning because of their
smaller size and less well-developed physiology.
Non-fatal poisoning appears to be more common
among children aged 1 to 4, with poisoning rates
increasing dramatically at around 2 years of age.1
Curiosity, tendency to place objects into the mouth
and imitate adults in medication-taking,
developmental ability of becoming more mobile,
lack of judgment and limited knowledge at this
certain age make them more likely to be victims of
unintentional poisoning. In addition, boys appear
to be at consistently higher risk of unintentional
poisoning. Such difference may be explained by the
fact that in some cultures, girls are expected not to
engage in outdoor activities or adopt risk-taking
behaviour.1 For young children, they are particularly
susceptible to the accidental ingestion of poison5,
especially liquid agents as they are easier to swallow
than solid compounds. Besides, clear liquids, small
solids, bright coloured solid medications are more
appealing to young children and thus more likely to
be ingested.1
common agents involved in unintentional childhood
poisoning are medications and household products.
In many low- and middle-income countries,
ingestion of hydrocarbon fuels (such as paraffin oil
or kerosene that are used for cooking, heating or
lighting) is a common cause. Children living in
agricultural communities are at higher risk of
acute pesticide poisoning.1 It is noteworthy that
unintentional poisoning in young children increas-
ingly involves medications.3 In the United States,
the number of children younger than 6 years who
were seen in poison centres after an accidental expo-
sure to medications had been increased by 33% be-
tween 2000 and 2010; medication deaths as a
percentage of all child poisoning deaths had also
nearly doubled since the late 1970s.6, 7 Reasons for
such increases include more medications than
ever are kept in the home (including prescription and
over-the-counter medications, dietary supplements,
vitamins and herbals). The pace of today’s lifestyle
also means that medications may not be properly
stored immediately after every use, especially when
medication users find it inconvenient to store medi-
cation in locked cabinets when they are used once or
several times a day. While young children may now
have greater access to grandparents’ medications
because of living in multi-generational households
or when busy parents rely on grandparents in caring
of chidlren, lack of knowledge among parents and
carers to take poisoning preventive measures, along
with neglect or insufficient supervision to children’s
curious impulsive behaviour increase the risk of
childhood poisoning. Besides, children’s medica-
tions that are formulated to taste good may also
entice children to take them when unsupervised.2, 3, 7 Depending on socioeconomic status, cultural
practices, local industries and agricultural activities,
the prevalence and types of poisoning vary
considerably globally. In developed countries as
well as some developing countries, the most
Non-Communicable Diseases Watch June 2014
Page 4
Unintentional Childhood Poisoning among Local Children
Non-Communicable Diseases Watch June 2014
In Hong Kong, unintentional childhood poisoning is
not uncommon. Between 2011 and 2013, data from
16 Accident and Emergency Departments under the
Hospital Authority showed that there were 793
unintentional poisoning cases among children aged
14 and below, in which 559 (70.5%) cases happened
in the home. As shown in Table 2, among the
unintentional childhood poisoning incidents in the
home, more cases happened in boys (54.2%) and
majority involved children aged 4 and below
(88.0%). By exposure to the main types of poison-
ing agents, most incidents in the home involved
western medications (63.5%), followed by house-
hold products (15.4%) and pesticides (6.2%)
(Table 3).8 Regarding mortality, there were four
registered deaths due to accidental poisoning in
the home among children aged 14 and below
between 2008 and 2012.9
Table 2: Number of unintentional poisoning incidents in the home among local children aged 14 and
below by sex, age and year of occurrence, 2011-2013
Year 2011 Year 2012 Year 2013 Total
Sex
Male 96 95 112 303
Female 88 85 83 256
Age (year)
0-4 163 154 175 492
5-9 14 19 17 50
10-14 7 7 3 17
Total 184 180 195 559
Sources: Hong Kong Poison Information Centre and Department of Health.
Prevention of Unintentional Childhood Poisoning in the Home
Unintentional poisoning is avoidable and preventa-
ble. Every effort should be made to prevent the
occurrence or to reduce the morbidity and
mortality of unintentional childhood poisoning.10
However, a survey conducted by the Department of
Health in 2008 showed that many households
were not vigilant enough in preventing domestic
poisoning. While 73.5% of households adopted
the preventive measures of not putting different
medications into the same container all the time,
26.9% of households did not label medications or
poisoning agents (such as household sanitary agents)
clearly at all (none of the time). Among the house-
holds with children aged below 11, about three-
fifths (59.3% ) of them reported that they failed to
use child-proof containers for storing medicines
all of the time and over one-quarter (28.6%) failed
to keep medications and poisoning agents out of
reach of children all of the time.11 In fact, many
childhood poisoning incidents can be prevented
if parents and carers implement appropriate preven-
tive measures in the home. Parents and carers should
also be vigilant of the signs and symptoms of
poisoning, and act fast in case of suspected
poisoning.
Page 5
Non-Communicable Diseases Watch June 2014
Note: * Some cases had exposed to more than one main type of poisoning agents.
Sources: Hong Kong Poison Information Centre and Department of Health.
Table 3: Number of unintentional poisoning in the home among local children aged 14 and below
by main types of poisoning agents , 2011-2013
Poisoning Agent Number of cases*
Western Medications 408 (63.5%)
Analgesics 60
Antihistamines 60
Cardiovascular drugs 42
Cold and cough preparations 42
Vitamins 29
Respiratory drugs 27
Sedatives and hypnotics 23
Anti-microbial 20
Gastro-intestinal drugs 20
Others 85
Household products 99 (15.4%)
Desiccants, dehumidifier and oxygen absorbent 26
Cleaners 17
Moth and mosquito repellent 15
Bleaches 8
Battery, toys and foreign bodies 8
Others 25
Pesticides 40 (6.2%)
Insecticides 34
Rodenticides 2
Others 4
Cosmetics and personal care products 27 (4.2%)
Cream, lotion and make-up 13
Hair care products 4
Dental care products 2
Nail products 2
Others 6
Miscellaneous 69 (10.7%)
Metals 17
Chinese and alternative medicines 11
Alcohol 10
Bites and envenomations 7
Fumes, gases and vapours 4
Industrial products 2
Others 18
Overall 643 (100.0%)
Page 6
Implementing preventive measures in the home
While parents and carers should take time to teach
children about poisoning and tell them not to put
things into their mouth casually, young children
may not understand or remember what is dangerous.
Therefore, the best way to keep children safe from
poisoning is to ensure that they cannot get to them.
Here are some dos and don’ts that can help reduce
the risk of childhood poisoning in the home: 12-15
Check every corner in the home for poisoning
agents (medications, cleansing products and
chemicals, cosmetics and personal care
products, poisonous plants, cockroach baits and
rat baits). Put all poisoning agents out of reach
of children immediately after buying or using
them. Be aware of any medications or
cosmetics that are in the handbag, and store the
handbag out of reach of young children too.
Keep poisoning agents in their original
child-proof and clearly labelled bottles or
containers. Use child-resistant locks on cup-
boards containing cleansing fluids and other
household chemicals. Dispose out-of-date or
unwanted medications, chemicals and batteries
properly.
Keep children away from treated areas where
pesticides are applied. Closely supervise young
children in and around the home. Handle the
poisoning household products carefully when
using them since children may ingest them
when adults are focusing on their work.
Read the labels carefully and follow the
instructions strictly when giving medications to
children. Be careful with overdose due to
multiple medications which may contain the
same ingredients (e.g. giving syrup and rectal
paracetamol at the same time). Use the dosing
device that comes with the medications (note:
kitchen spoons are not all the same, and tea-
spoon and tablespoon used for cooking may not
measure the same amount as the dosing device).
Give medications in a well-lit place to avoid
dosing errors. Tell children that medications
and household products are not candies or food.
Do not stock medications that are not needed.
Do not put poisonous products in food
containers or drink bottles which children
may mistake for food or drink. Do not store
medications in the fridge or cupboards where
children expect to find food or drink. Do not
remove the labels on the medications or house-
hold products.
Do not give extra amount of medications to
children even if they have missed the previous
dose, or give other people’s medications or
those left from a previous consultation to
children.
Do not apply pesticides directly to household
utensils or surface used for food preparation.
Recognising the signs and symptoms of poisoning
in children
Most poisons (with the exception of heavy metals
such as lead) work fairly quickly. Parents and
carers should be vigilant to the possibility of
poisoning if they find an opened or spilled bottle
of pills, or if they see suspicious stains on children’s
mouth or clothing, or the otherwise well children
develop unusual signs and symptoms. Possible
warning signs and symptoms associated with poi-
soning include 12, 13:
* Hacking cough or trouble breathing
* Nausea and/or vomiting
* Abdominal pain
* Swollen or red eyes
* Rash, red or burned lips, mouth or skin
* Seizures
* Drowsiness or unconsciousness (in extreme
cases)
Non-Communicable Diseases Watch June 2014
Page 7
Acting fast in case of suspected poisoning 15
Deaths and disabling sequelae in children
following poisoning can be prevented or minimised
by acting fast. When a child is suspected of poison-
ing, parents and carers should:
Keep calm;
Seek medical attention promptly;
Call 999 emergency hotline immediately if the
condition is serious.
For more educational resources about poisoning,
please visit the website of the Hong Kong
Poison Control Network at http://www.hkpcn.org.hk/
eng/Index2.html.
References
1. Peden M, Oyegbite K, Ozanne-Smith J, et al. World Report on
Child Injury Prevention. Geneva: World Health Organization,
2008.
2. Anderson M. Poisoning in young children. Arch Dis Child 2012;
97(9):831-2.
3. Bond GR, Woodward RW, Ho M. The growing impact of
pediatric pharmaceutical poisoning. J Pediatr 2012; 160(2):
265-270 e1.
4. GBD 2010 Change in Leading Causes and Risks between 1990
and 2010. Institute for Health Metrics and Evaluation, 2012.
5. Shannon M. Ingestion of toxic substances by children. N Engl
J Med 2000; 342(3):186-91.
6. Spiller HA, Beuhler MC, Ryan ML, et al. Evaluation of changes
in poisoning in young children: 2000 to 2010. Pediatr Emerg
Care 2013; 29(5):635-40.
7. Safe Storage, Safe Dosing, Safe Kids. A Report to the Nation on
Safe Medication. Washington, D.C.: Safe Kids Worldwide,
2012.
8. Poisoning Statistics from Accident and Emergency Departments
under the Hospital Authority. Hong Kong SAR: Hong Kong
Poison Information Centre and Department of Health.
9. Mortality Statistics, 2008-2012. Hong Kong SAR: Department
of Health and Census and Statistics Department.
10. Yip WL, Ng HW, Tse ML, Lau FL. An epidemiological study
of paediatric poisoning in Hong Kong. HK J Paediatr 2011
(16):25-31.
11. Injury Survey 2008. Hong Kong SAR: Department of Health.
12. Accidental Poisoing in Children. Melbourne: Victorian
Government, 2010.
13. Prevent Accidental Poisoning. Parenting Rules. Rhodes Island:
Prevent Child Abuse, 2010.
14. Kids and Poisons. Sydney: Kids Health and the NSW
Poisonings Information Centre, 2010.
15. Prevention of Childhood Poisoning. Hong Kong SAR:
Hong Kong Poison Control Network and Department of Health.
Non-Communicable Diseases Watch June 2014
Non-Communicable Diseases Watch June 2014
Protecting Children and Adolescents from Alcohol-related Harm
Many FIRST things in life come from parents. Do parents give the BEST to the children they love?
As parents and guardians, they should know that alcohol is a component cause in more than 200 diseases and
injury conditions, including certain cancers, cardiovascular diseases, liver cirrhosis, falls and drowning.
Children and adolescents are at particular risk of immediate, short- and long-term alcohol-related harm,
which affects their physical, intellectual, social and mental development. Early initiation of drinking is also
shown to be a powerful predictor of alcohol dependence and abuse in later age. Thus, there is no place for
alcohol in a child or adolescent’s life. To protect children and adolescents from alcohol-related harm,
parents and guardians should be role models by not drinking and not exposing children and adolescents to
alcohol. Remember the 3 Don’ts:
* Don’t let children and adolescents drink
* Don’t give children and adolescents alcohol
* Don’t pressure children and adolescents to drink
The public may visit the Centre for Health Protection's webpage on ‘Alcohol and Health’ (www.chp.gov.hk/
en/view_content/34286.html) for more information.
Non-Communicable Diseases (NCD) WATCH is dedicated to
promote public’s awareness of and disseminate health information
about non-communicable diseases and related issues, and the
importance of their prevention and control. It is also an indication of
our commitments in responsive risk communication and to address
the growing non-communicable disease threats to the health of our
community. The Editorial Board welcomes your views and comments.
Please send all comments and/or questions to so_dp3@dh.gov.hk.
Editor-in-Chief
Dr Regina CHING
Members
Dr Thomas CHUNG Dr Eddy NG
Dr Cecilia YM FAN Dr Karen TSO
Dr Anne FUNG Ms Faith WAN
Dr Winnie LAU Dr Lilian WAN
Dr Ruby LEE Dr Monica WONG
Mr YH LEE Dr Priscilla WONG
Page 8
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